M
i f l U
f H lth
Meaningful Use of Health
Information Technology Requires a
Competent Workforce
William Hersh, MD Professor and Chair Department of Medical Informatics & Clinical Epidemiology Oregon Health & Science UniversityOregon Health & Science University Portland, OR, USA
Overview of talk
Overview of talk
•
Why we need more health information
Why we need more health information
technology (HIT)
•
What we know about the HIT workforce
•
What we know about the HIT workforce
The biggest advocate for HIT
The biggest advocate for HIT
•
“To improve the quality of our
To improve the quality of our
Health Information Technology for
i
d li i l
l h (
)
Economic and Clinical Health (HITECH) Act
•
Portion of the American Recovery and
y
Reinvestment Act (ARRA) that allocates $40
billion to the Office of the National Coordinator
for Health IT (ONC) to provide incentives for
for Health IT (ONC) to provide incentives for
“meaningful use” of HIT through
–
Adoption of electronic health records (EHRs)
–
Health information exchange (HIE)
–
Infrastructure
•
Regional extension centers – 60 across country
Regional extension centers 60 across country
•
Research centers – four centers in specific areas
Why do we need more information
h
l
( ) i h l h
?
technology (IT) in healthcare?
•
Quality – not as good as it could be
Quality not as good as it could be
(McGlynn 2003;(McGlynn, 2003; NCQA, 2009; Schoen, 2009)•
Safety – IOM “errors report” found up to
y
p
p
98,000 deaths per year
(Kohn, 2000)•
Cost – rising costs not sustainable; US spends
Cost rising costs not sustainable; US spends
more but gets less
(Angrisano, 2007)•
Inaccessible information missing information
•
Inaccessible information – missing information
What do we know about the HIT
kf
workforce?
•
Largest (but not only) need now in healthcare settings
•
Traditional groupings of professionals in healthcare
–
Information technology (IT) – usually with computer
science or information systems background
science or information systems background
–
Health information management (HIM) – historical focus
on medical records; certified as
•
Registered Health Information Administrator (RHIA)
Registered Health Information Administrator (RHIA)
•
Registered Health Information Technologist (RHIT)
•
Clinical Coding Specialist (CCS)
–
Clinical informatics (CI) – often from healthcare
Clinical informatics (CI) often from healthcare
backgrounds; focus on use of clinical information
What do the data show?
What do the data show?
•
Mostly done in hospital settings; usually
Mostly done in hospital settings; usually
focused on one (of three main) groups
–
IT – HIMSS Analytics Database™ study
–
IT – HIMSS Analytics Database study
HIMSS Analytics study
y
y
(Hersh and Wright, 2008)
Results
Results
•
IT per non‐IT staff ~ 1:60
0.25p
•
IT FTE per bed rises from
stages 0 to 4
•
Extrapolating to country
0.1 0.15 0.2 FT E per B e d•
Extrapolating to country
as a whole
–
108,390 IT staff at current
d
i
l
l
0 0.05 0 1 2 3 4 5 6 7 ITadoption levels
–
Would increase to 149,174
if all stages <4 hospitals
d t
t
4
EMR Adoption Model™ Score
HIM data from US Bureau of Labor
Statistics
•
From US Bureau of Labor Statistics
From US Bureau of Labor Statistics
occupational employment projections 2008‐
2018 (BLS 2009)
2018 (BLS, 2009)
–
Medical Records and Health Information
Technicians (RHITs and coders) – about 172,500
Technicians (RHITs and coders) about 172,500
employed now, increasing to 207,600 by 2018
(20% growth)
Clinical informatics
Clinical informatics
•
Individuals who bring skills at intersection of health
care and IT
(Hersh, 2008; Hersh, 2009)–
Focus more on information than technology
–
Likely to lead “meaningful use” of HIT
Likely to lead meaningful use of HIT
•
Estimates of need
–
One physician and nurse in each US hospital (~10,000)
(Safran 2005)(Safran, 2005)
–
About 13,000 in health care
(Friedman, 2008)and 1,000 in public
health
(Friedman, 2007)–
Growing role of CMIO and other CI leaders
Growing role of CMIO and other CI leaders
(Leviss 2006 Shaffer(Leviss, 2006, Shaffer, 2009)ONC estimates 51,000 needed for
d
b
l
HITECH agenda in 12 job roles
•
Mobile Adoption Support Roles
l l * – Implementation support specialist* – Practice workflow and information management redesign specialist* – Clinician consultant* – Implementation manager*p g•
Permanent Staff of Health Care Delivery and Public Health Sites
– Technical/software support staff* – Trainer* Cli i i / bli h l h l d † – Clinician/public health leader† – Health information management and exchange specialist† – Health information privacy and security specialist†•
Health Care and Public Health Informaticians
Health Care and Public Health Informaticians
How do we build the workforce?
How do we build the workforce?
•
Historically most education at graduate level
–
Informatics is inherently multidisciplinary and there is no
single job description or career pathway
•
More information on programs on AMIA web site
More information on programs on AMIA web site
–
http://www.amia.org/informatics‐academic‐training‐
programs
•
Commentary at
•
Commentary at
–
http://informaticsprofessor.blogspot.com
•
Let’s look at
–
Competencies
–
Career pathways
Career pathways have diverse inputs
d
and outputs
(Hersh, 2009)There is no single
Health care professions, e.g., medicine, nursing, etc.There is no single
career pathway!
Natural and life sciences, e.g., biology, genetics, etc.Computer science (CS) IT and
Jobs in: • Health care systems • Clinical leadership IT l d hi Biomedical and health informatics Computer science (CS), IT, and undergrad informatics Health information • IT leadership • Biomedical research • Industry • Academia education (usually graduate level) management (HIM) Others, e.g., business, library and info science
level)